上呼吸道感染患儿全身麻醉的安全性分析

Safety analysis of general anesthesia for children with upper respiratory infection

目的探讨全身麻醉在不同年龄轻中度上呼吸道感染（Upper respiratory infection,URI）患儿应用中的安全性,为临床治疗提高参考依据。方法于2010年2月-2013年9月手术室安排179例择期手术患儿,依据URI程度分级将患儿分为3组,分别为无URI组102例、轻度URI组49例、中度URI组28例,比较3组患儿麻醉期间呼吸系统不良事件发生率及临床指标,数据采用SPSS 13.0软件进行统计分析。结果年龄≤3岁患儿无URI组、轻度URI组与中度URI组在咳嗽、屏气比较,中度URI组发生率明显增高,差异有统计学意义（P〈0.05）;4∽12岁患儿各组之间比较,差异无统计学意义;各组均未出现喉痉挛、支气管痉挛以及发热;年龄≤3岁、4∽12岁患儿术中心率比较,中度URI组高于无URI组,差异有统计学意义（P〈0.05）;年龄≤3岁患儿术中心率比较中度URI组高于轻度URI组,差异有统计学意义（P〈0.05）。结论年龄≤3岁合并轻度URI患儿,年龄4∽12岁的合并轻中度URI患儿实施气管插管全身麻醉相对安全,而年龄≤3岁合并中度URI患儿进行气管插管全身麻醉时并发症率较高,存在一定风险,因此对于此类患儿则应进行更全面风险评估,把握主次,慎重选择是否实施全身麻醉。

OBJECTIVE To explore the safety of general anesthesia for children in different ages with slight and moderate upper respiratory infection （URI） so as to provide references for clinical treatments .METHODS Totally 179 children who received operation in our hospital from Feb .2010 to Sep .2013 were selected as the study ob‐jects ,and they were divided into 3 groups according to their URI stage ,including no URI group （102 cases） ,mild URI group（49 cases） and moderate URI group （28 cases） .The incidence rate of adverse events and clinical inde‐xes of these groups were monitored and compared .All data wre analyzed by SPSS 13 .0 software .RESULTS The incidence rate of cough and breath holding of children younger than 3 years in no URI group ,mild URI group and moderate URI group had significantly differences and the rate was the highest in the moderate URI group .The differences were significant （P〈0 .05）;at the age of 4 to 12 ,differences between the three groups were not sig‐nificant （P＆gt;0 .05） .No laryngospasm ,bronchospasm and fever were found in 3 groups ;in children younger than 3 and aged from 4 to 12 ,the heart rate of moderate URI group was higher than no URI group ,and the difference had significance （P〈0 .05）;and for children younger than 3 ,the heart rate of moderate URI group was higher than mild URI group ,and the difference was significant （P〈0 .05） .CONCLUSION It′s relatively safe that apply‐ing general anesthesia in children who is younger than 3 years with mild URI ,and those aged from 4 to 12 with moderate URI .But for moderate URI children aged less than 3 ,the complication incidence is higher when applying general anesthesia with certain risks .Hence comprehensive risk evaluation should be done for these children and general anesthesia should be chosen carefully .